Bipartisan, Bicameral Effort Underway to Advance Medicare Post-Acute Reform
House Ways and Means and Senate Finance Committees Release Draft Legislation to reform post-acute care; NAHC submitted proposals to the Committees last summer offering the home health and hospice perspective
March 22, 2014 10:34 AM
Ways and Means Committee Chairman Dave Camp (R-MI) and Ranking Member Sandy Levin (D-MI) along with Senate Finance Committee Chairman Ron Wyden (D-OR) and Ranking Member Orrin Hatch (R-UT) released a discussion draft titled, Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act of 2014). The IMPACT Act of 2014 aims to update Medicare payments to post-acute care (PAC) providers by focusing on more accountable care, and moving towards more of a quality-driven PAC benefit. The draft legislation is intended to serve as the core building block for future Medicare PAC reforms between the House and Senate Committees that have jurisdiction over Medicare policy.
Last year, Committee leaders invited interested stakeholders to submit ideas on how to strengthen post-acute care (PAC), a variety of health care services that support a patient's continued recovery from a serious illness. Post-acute care includes services in Long Term Care Hospitals (LTCHs), Inpatient Rehabilitation Facilities (IRFs), Skilled Nursing Facilities (SNFs), and Home Health Agencies (HHAs). The resounding theme from the more than 70 letters received was the need for standardized post-acute assessment data across Medicare PAC provider settings. NAHC submitted extensive comments and recommendations on post-acute care reforms.
For more on the comments NAHC submitted to the committees on how to reform to post-acute care, please see NAHC Report, September 4, 2013.
The IMPACT Act of 2014 is based on the policy and legislative recommendations of more than 70 stakeholders in the health care community and will help lay the groundwork for the modernization of PAC services within Medicare to ensure the program works better for beneficiaries and taxpayers alike.
Without comparable information across PAC settings, policymakers and providers cannot determine whether patients treated and the care provided in different settings is, in fact, the same or whether one PAC setting is more appropriate. Absent this information, it is difficult to move forward with PAC payment reforms.
The IMPACT Act of 2014 requires standardized data that will enable Medicare to:
Compare quality across PAC settings;
Improve hospital and PAC discharge planning; and,
Use this information to reform PAC payments (via site neutral or bundled payments or some other reform) while ensuring continued beneficiary access to the most appropriate setting of care.
This bill can inform changes that the lawmakers believe will better enable Medicare patients to receive the right high-quality, post-acute care in the right setting at the right time.
Following the release of the discussion draft, the Committee leaders will work with their colleagues and experts within the health care community to further improve the legislative draft, with the goal of formally introducing consensus legislation in the future.
NAHC attended a briefing on the proposal on March 20. The staff from the Senate Finance Committee and the House Ways & Means Committee emphasized that payment and service reforms in post-acute care require a solid foundation in valid data. They view the proposal as a means to create that foundational database with the development of a uniform PAC patient assessment instrument, the establishment of quality of care measures, and the integration of the tools with hospital discharge planning.
At the end of these data development efforts is an analysis of potential payment reforms by CMS and MedPAC. Potential reforms include PAC bundling, a PAC prospective payment system, and site-neutral payments. However, congressional staff expressed that such reforms are likely at some extended time in the future. The timeline that was discussed had a MedPAC report to Congress on payment reforms due in 2022.
Overall, NAHC is supportive of developing a uniform patient assessment instrument for post-acute care. It is hoped that the development of such tool will build on experiences with OASIS and the CARE tool that was piloted recently. As constructed, the congressional proposal aims to transition PAC providers slowly to any new assessment processes, doing so in a way that avoids undue burdens. That may be easier said than done.
In the briefing, NAHC recommended that the proposal be revised to add a requirement that CMS develop the reforms through engagement and consultation with all PAC stakeholders.
A summary of the discussion draft can be found here.
A more detailed section-by-section review can be found here.